Individual
KORD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10116 E TARRAGON AVE, MESA, AZ 85212-8416
(480) 313-8783
Mailing address
10116 E TARRAGON AVE, MESA, AZ 85212-8416
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
60455959
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
135172
WA
Other
Enumeration date
04/20/2021
Last updated
06/05/2021
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